2006-05-02_REPORT - M1988022

• Permit No: M1988022
• IBM Index Class Name: Report
• Doc Date: 5/2/2006
• Doc Name: Annual Fee/Report/Map
• From: Lincoln County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
I/AN1~IIiAi. FF,F. and RF.PnRT RF.t1iiF.ST
'' Lincoln County
v M-19sa-ozz
Smith Ranch Pit No 2
May 16, 2006
REG~'~~/~D
tilAY ~ 21006
..
i/ IYmiein W MiI .,. CIS and ::~dyp
$281.00 (Due on or before your anniversary date)
Lincoln
Iv~v~Z
According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an
operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected
land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to ___ _ _
---occur-during-the upcoming year,`recla`mation tliaCwill-be performed du`rin'g the coming year, the dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
Please attach ynnr revised written anm~al rennrf and annnal rep nn rt main to this Snrm_ please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Don Blake
Permittee Name: Lincoln County
Addre$s: '~e'ri=1C3Q0I G~3 T
P.O. Box 39
Phone Number:
Fax Number:
Hugo, CO 80821
[phone]
[phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are
enclosed.
Signature of Corporate Officer, Owner, or Designee
©~-07-0(0
Date
MiPERMIIIMASTERDOCUMENTSVvI-AF-04